Definition Fresh Frozen Plasma (FFP) is the fluid portion of one unit of human blood that has been centrifuged, separated and frozen solid at -18c within eight hours of collection
PREPARATION & STORAGE Plasma is obtained by centrifugation of whole blood or by apheresis wherein plasma is filtered and the remaining part of the blood is pumped back into the donor. 1 unit of FFP is 200ml which is obtained from 1unit of whole blood i.e 450-500ml. Plasma so obtained is frozen at -18C or below. It can be stored at -18C for 24 months, at -36C for 36 months. It is thawed in a water bath at 37C or in a microwave thawing device.
ADMINISTRATION FFP should be transfused within 24hrs after thawing during this period it has to be stored at 1-6C. It must be ABO compatible with recipient RBC. The dose is 10-15ml/kg. This constitutes approx. 25-30% replacement therapy for coagulation factors.
FFP contains labile as well as stable components of the coagulation, fibrinolytic and complement systems, the protiens that maintain oncotic pressure and modulate immunity. In addition fats, carbohydrates and minerals are present in concentrations similar to circulation.
The analysis of 35 samples of FFP show mean concentrations of 535mg/dl Glucose, 172mEq/L Na+, 73mEq/L Cl-, 3.5mEq/L K+, 15mEq/L HCO3- and 5.5g/dl protien with 60% albumin.
Thus FFP is a hyperosmolal, hyperglycemic, hypernatremic and hypochloremic solution.
It is a less effective volume expander than other albumin containing solutions, due to its lower albumin content.
INDICATIONS Indications are generally limited to treatment of deficiencies of coagulation proteins for which specific factor concentrates are unavailable or undesirable. Replacement of specific factor deficiencies: FFP is efficacious for treatment of deficiencies of factors ii, v, vii, ix, x and xi when specific component therapy is neither available nor appropriate. 2. Reversal of warfarin effect: Pt. anticoagulated with warfarin who are actively bleeding or who require emmergency surgery, FFP can be used to achieve immediate haemostasis.
Indications cont…… 3. Massive blood transfusion: It is very common to have blood clotting abnormalities (prolonged APTT,INR) after large blood loss requiring for example 4 units or more of packed RBC. FFP is commonly recommended in these settings. 4.Use in Antithrombin iii defeciency: FFP can be used as a source of antithrombin iii in Pt. who are deficient in this inhibitor and are undergoing surgery or who require heparin for treatment of thrombosis. 5.Treatment of immunodeficiency's: FFP is useful in infants with secondary immunodeficiency associated with severe protein-losing enteropathy and in whom TPN is ineffectual. FFP can also be used as a source of Ig for children and adults with humoral immunodeficiency. However the development of a purified Ig for IV use has largely replaced FFP. 6.Treatment of Thrombotic Thombocytopenic Purpura.
ADVERSE EFFECTS FFP has similar effects as blood transfusion which are…… Disease transmission Anaphylactiod reaction Alloimmunization Transfusion Related Acute Lung Injury(TRALI) Increased infection (including surgical wound infection).